Apparatus and methods for the delivery of medicaments to the respiratory system

ABSTRACT

An apparatus for delivery of a medicament to the respiratory system comprises a reservoir that is adapted to hold a liquid medicament that is to be delivered to a respiratory system. An aerosol generator is provided that is adapted to aerosolize the liquid medicament. A liquid supplier is used to deliver the liquid medicament from the reservoir to the aerosol generator. A connector is operably coupled to the aerosol generator and comprises a gas conduit having an inlet, and an outlet, and an aerosol supply conduit. The aerosol generator is configured to provide the aerosolized liquid medicament into the gas conduit through the aerosol supply conduit, and the gas conduit is adapted to pass gases to entrain the aerosolized liquid medicament.

CROSS-REFERENCES TO RELATED APPLICATIONS

[0001] This application is a continuation-in-part application and claimspriority from copending PCT/IE/00051 filed on May 5, 2000, the completedisclosure of which is incorporated herein by reference.

BACKGROUND OF THE INVENTION

[0002] This invention relates to methods and apparatus for delivery ofmedicament to the respiratory system of a patient. In particular, theinvention relates to apparatus and methods of this type for use inassociation with a nebulizer.

[0003] It is known to use a nebulizer to create an aerosol of medicationfor delivery into the respiratory system of a patient. Typically themedication is placed in a cup which is held over a reservoir of bufferwater. A piezoelectric element is vibrated ultrasonically under thebuffer water transferring energy to the water, thus causing an aerosolto be formed in the medication cup. Baffles are provided between themedication cup and the airway in an attempt to ensure large particles ofmedication rain out on the filter and drip back down into the medicationcup.

[0004] These nebulizers suffer from a number of disadvantages. Inparticular, medications have a range of different viscosities, howeverparticle generation is not consistent across the range. Thus themedication particle size is not accurately controlled and a broad rangeof particles pass into the patient airway. Nebulized medication whichrains out on the filter drips back into the cup only to be nebulizedagain. This may degrade or destroy the medication.

[0005] The medication in the cup is directly exposed to the airway.Therefore the nebulizer must be maintained substantially horizontal atall times to prevent medication spilling out into the patient airway.Also the ventilator pressure will be lost when the medication cup isremoved to refill it.

[0006] This method of aerosol generation requires a relatively largeamount of energy, the response time of aerosol generation is thus large.A considerable amount of heat is generated during use of the nebulizer,therefore to prevent patient discomfort or injury the nebulizer isplaced away from the patient. However this necessitates a longinhalation tube between the nebulizer and the patient, increasing drugloss through rain out along the inhalation tube, and further increasingthe response time to patient inspiration. Further, the generated heatdegenerates the medication, which can be particularly harmful to proteinbased drugs.

[0007] Hence, this invention is related to apparatus and techniques fordelivery of medicament to the respiratory system of a patient.

BRIEF SUMMARY OF THE INVENTION

[0008] In one embodiment, an apparatus for delivery of medicament to therespiratory system comprises a reservoir, such as a medication cup, forreceiving a liquid medication that is to be delivered to a respiratorysystem. The apparatus also includes an aerosol generator that may beheld within a housing. A liquid supplier is provided to deliver theliquid medicament from the cup to the aerosol generator. A connector isemployed to receive aerosol generated by the aerosol generator. Theconnector has an aerosol inlet for receiving aerosol from the generator,an air inlet, and an outlet. In this way, the aerosol that is receivedthrough the aerosol inlet may be entrained with a gas passing throughthe air inlet, and the entrained aerosol may pass through the outlet fordelivery to a patient. Conveniently, the connector may be coupled to aventilator to introduce the gas into the air inlet.

[0009] In one aspect, the connector is of generally T-shape and has aninlet leg with a longitudinal axis and an outlet leg with an air inletend and an aerosol outlet end. The inlet is connected to the outlet legintermediate the air inlet end and the aerosol outlet end, and theoutlet leg has a first portion extending from the air inlet end to theconnection to the inlet leg. The first portion has a longitudinal axis,with the longitudinal axis of the inlet leg subtending an angle of lessthan 90° with the longitudinal axis of the first portion of the outletleg. Preferably the angle between the longitudinal axis of the firstportion of the outlet leg and the longitudinal axis of the inlet leg isless than 80°. Ideally the angle between the longitudinal axis of thefirst portion of the outlet leg and the longitudinal axis of the inletleg is about 75°. In some cases, the outlet leg may have a secondportion extending from the first portion, the second portion beingsubstantially in line with the first portion.

[0010] Conveniently, the connector may also be defined in terms of a gasconduit having an inlet, and an outlet, and an aerosol supply conduit.With such a configuration, the aerosol generator is configured toprovide the aerosolized liquid medicament into the gas conduit throughthe aerosol supply conduit, and the gas conduit is adapted to pass gasesto entrain the aerosolized liquid medicament.

[0011] In another embodiment of the invention, the medication cup isreleasably mounted to the aerosol generator housing. In one aspect, themedication cup has a reservoir for holding a medication and a deliverytube having an inlet for receiving medication from the reservoir. Thedelivery tube is associated with the liquid supplier to deliver theliquid medication to the aerosol generator. The inlet may comprise anumber of inlet slots which are circumferentially spaced-apart aroundthe delivery tube.

[0012] The aerosol generator housing and the medication cup may beconfigured to be sealed to each other. This may be accomplished using asealing mechanism, such as a skirt extending from the aerosol generatorhousing to sealingly engage the medication cup. Conveniently, the skirtmay have an angled surface to sealingly engage a chamfered mouth of themedication cup. In a further aspect, the liquid supplier may be mountedto the aerosol generator housing.

[0013] In a further embodiment, the medication cup has a base withsupport for supporting the cup in an upright orientation when receivingliquid medication. The support may comprise a support skirt extendingfrom the base of the cup. Conveniently, the medication cup may include acentral well from which the delivery tube extends.

[0014] In one embodiment, the apparatus includes controller forcontrolling the operation of the aerosol generator. For example, thecontroller may send control signals to actuate the aerosol generatorjust prior to initiating an inhalation cycle of a ventilator and todeactivate the aerosol generator just after termination of theinhalation cycle of the ventilator. Conveniently, the controller may bethe same controller used to control the ventilator. In one aspect, theaerosol generator housing has a signal connector to which a controlsignal from the controller is inputted to control the operation of theaerosol generator. An interface may also be used to interface theaerosol generator with the controller. The interface may be mountedremote from the aerosol generator housing.

[0015] In another aspect, the liquid supplier is mounted to the aerosolgenerator housing. In this way, the liquid supplier and the aerosolgenerator are configured as a single unit. In a further aspect, themedication cup may be releasably mounted to the aerosol generatorhousing. As such, the medication cup may easily be removed whenrefilling and/or replacement is needed.

[0016] According to another embodiment of the invention, a connector isprovided for delivery of medicament to the respiratory system. Theconnector comprises a generally T-shaped device having an inlet leg witha longitudinal axis and an outlet leg with an air inlet end and anaerosol outlet end. The inlet leg is connected to the outlet legintermediate the air inlet end and the aerosol outlet end. The outletleg has a first portion extending from the air inlet end to theconnection to the inlet leg. The first portion has a longitudinal axissubtending at an angle of less than 90° with the longitudinal axis ofthe inlet leg.

[0017] In one aspect, the angle between the longitudinal axis of thefirst portion of the outlet leg and the longitudinal axis of the inletleg is less than 80°. Ideally, the angle between the longitudinal axisof the first portion of the outlet leg and the longitudinal axis of theinlet leg is about 75°. The outlet leg may have a second portionextending from the first portion, with the second portion beingsubstantially in line with the first portion.

[0018] In another embodiment, the invention provides a medication cupfor receiving liquid medication for delivery to an aerosol generator.The medication cup has a reservoir for holding a medication andconnector for connection to an aerosol generator. The medication cup hasa releasable seal for maintaining the medication in the cup.

[0019] In one embodiment of the invention, the releasable seal comprisesa sealing sheet releasably attached to the cup. Conveniently, a peel tabor other release mechanism may be used to remove the sheet.Alternatively the release mechanism may be a tab or other opener toperforate the sealing sheet when the cup is connected to the aerosolgenerator. The sheet may conveniently have an identifying code.

[0020] The invention further provides a nebulizer system for use with aventilator circuit. The system comprises at least one tubing sectionhaving an inlet and an outlet for delivering air or other gases to apatient from a ventilator. The system further includes a nebulizer whichdelivers a nebulized fluid to the tubing section for inhalation by apatient on the ventilator. The nebulizer has a vibrating element havinga front side, a back side and a plurality of openings. A fluid deliverysystem is employed to deliver fluid to the back side of the vibratingelement. With this configuration, vibration of the vibrating elementmoves fluid from the back side of the vibrating element through theplurality of openings to produce the nebulized fluid which enters thetubing section for delivery to the patient.

[0021] In one aspect, the tubing section forms an air path and thesource of fluid is separated from the air path by the vibrating element.In another aspect, the tubing section includes a T-shaped section.Conveniently, the source of fluid may include a capillary feed systemwhich provides fluid to the back side of the vibrating element, and thevibrating element may comprise a ring-shaped piezoelectric element. Theopenings in the vibrating element may be sized to eject liquid dropletssuch that about 70% or more of the droplets by weight have a size in therange from about 1-5 micrometers.

[0022] In a further embodiment, a nebulizing device comprises anebulizing element, and a fluid delivery system to deliver a fluid tothe nebulizing element. At least one tube section is employed to definea delivery path to the patient. This delivery path is convenientlydefined by a distance between the nebulizing element and the patient,and has a length of less than 500 mm, and preferably less than about 300mm.

[0023] In one aspect, the nebulizing element has a vibrating elementwith openings therein. The vibrating element also has a front side and aback side, and the delivery path is defined at one end by the front sideof the vibrating element. With this configuration, the fluid isdelivered through the openings in the vibrating element upon vibrationof the vibrating element, with the fluid being delivered to the backside of the vibrating element.

[0024] In another aspect, the tube section includes a T-shaped sectionhaving a top section and a central section, and the nebulizing elementis positioned at a bottom of a central section. Ideally, the centralsection forms an angle of from 60° to 80° with a straight portion of theT-shaped section. In a further aspect, the tube section may include aY-shaped section which separates into a first arm for inhalation and asecond arm for exhalation. With this arrangement, the nebulizing elementis coupled to a second tube section which is connected to the Y-section.Desirably, the second tube section is a T-shaped section which isattached to the Y-section. Preferably, the delivery path through thetube section is substantially free of baffles and flow disrupters.

[0025] The invention also provides a method of providing a nebulizedfluid to a patient. According to the method, a vibratable member havinga plurality of apertures that is in contact with a fluid is vibrated toproduce a nebulized fluid. The nebulized fluid is permitted to ejectinto a conduit that is coupled to a ventilator. A gas from theventilator is then employed to supply the aerosolized fluid to thepatient's airway. Alternatively, the nebulized fluid may be provided tothe patient using other techniques, such as by patient inhalation.

[0026] In one aspect, the distance between the vibratable member and thepatient is less than about 500 mm, and in some cases less than about 300mm. In this way, minimal tubing may be used to supply the aerosolizedfluid to the patient, thereby requiring less energy to nebulize thefluid and reducing the generated heat so that the medication is notcompromised.

[0027] The invention further provides a ventilator circuit thatcomprises a nebulizing element, and a fluid delivery system fordelivering fluid to the nebulizing element. A ventilator is used todeliver and withdraw air from a patient. A control system is operablycoupled to the nebulizing element and the ventilator. The control systemis used to activate the nebulizing element during an inhalation cyclewhere respiratory gases are being supplied to the patient by theventilator. For example, the controller may activate the nebulizingelement within about 20 milliseconds of initiation of an inhalationcycle and deactivate the nebulizing element within 20 milliseconds oftermination of the inhalation cycle. In this way, the aerosol isgenerated essentially only when gases are being supplied to the patient.

[0028] In one aspect, the nebulizing element has a vibrating elementwith openings therein, and a front side and a back side. The fluid isdelivered through the openings in the vibrating element upon vibrationof the vibrating element, and the fluid is provided to the back side ofthe vibrating element.

BRIEF DESCRIPTION OF THE DRAWINGS

[0029] The invention will be more clearly understood from the followingdescription of some embodiments thereof, given by way of example only,with reference to the accompanying drawings, in which:

[0030]FIG. 1 is a perspective view of an apparatus for delivery ofmedicament to a respiratory system according to the invention;

[0031]FIG. 2 is a perspective view of a controller;

[0032]FIG. 3 is a perspective view of a connector piece of the apparatusof FIG. 1;

[0033] FIGS. 4(a) to 4(d) are elevational views of the apparatus of FIG.1 in different orientations;

[0034]FIG. 5 is a perspective view from above of a medication cup of theapparatus of FIG. 1;

[0035]FIG. 6 is a perspective view from beneath of the medication cup ofFIG. 5;

[0036]FIG. 7 is a perspective view from above of the medication cup ofFIG. 5 after sealing;

[0037]FIG. 8 is a side, cross-sectional view of the sealed medicationcup of FIG. 7;

[0038]FIG. 9 is a perspective view from beneath of a liquid supplier ofthe apparatus of FIG. 1 mounted to an aerosol generator housing of theapparatus of FIG. 1;

[0039]FIG. 10 is a perspective view from above of the aerosol generatorhousing of FIG. 9;

[0040]FIG. 11 is an exploded, side, cross-sectional view of theapparatus of FIG. 1;

[0041]FIG. 12 is a side, cross-sectional view of the apparatus of FIG. 1assembled;

[0042]FIG. 12(a) is an exploded, perspective view of the liquid supplierof FIG. 9;

[0043]FIG. 13 is a side view of the apparatus of FIG. 1 in use connectedto a face mask;

[0044]FIG. 14(a) is a front view of the apparatus and face mask of FIG.13;

[0045]FIG. 14(b) is a front view of the apparatus of FIG. 14(a) indifferent orientations;

[0046]FIG. 15 is a perspective view of a mouthpiece;

[0047]FIG. 16 is a side view of the apparatus of FIG. 1 in use connectedto the mouthpiece of FIG. 15;

[0048]FIG. 17(a) is a side view of the apparatus of FIG. 1 in useconnected to a tracheal tube;

[0049]FIG. 17(b) is a side view of the apparatus of FIG. 1 in anotherconfiguration of use connected to a tracheal tube;

[0050]FIG. 17(c) is a perspective view from beneath of anothermedication cup of the apparatus of FIG. 1;

[0051] FIGS. 18 to 20 are flow diagrams illustrating operationalarrangements for using the apparatus of FIG. 1;

[0052]FIG. 21(a) is a plan view of a rear side of the controller circuitof FIG. 2;

[0053]FIG. 21(b) is a perspective view along the rear side of thecontroller circuit of FIG. 21(a);

[0054]FIG. 21(c) is a perspective view of a mounting device according tothe invention;

[0055]FIGS. 22 and 23 are perspective views of the mounting device ofFIG. 21(b) in use with the controller circuit of FIG. 21(a);

[0056]FIG. 24 is an exploded, perspective view of another mountingdevice according to the invention in use with the controller circuit ofFIG. 21(a); and

[0057]FIG. 25 is a side view of the apparatus of FIG. 1 in use with thecontroller circuit of FIG. 21(a) and the mounting device of FIG. 24.

DESCRIPTION OF THE SPECIFIC EMBODIMENTS

[0058] Referring to the drawings and initially to FIG. 1 thereof, thereis illustrated an apparatus 1 according to the invention for thedelivery of medicament to the respiratory system of a patient. Theapparatus 1 comprises a medication cup 2, an aerosol generator 3, ahousing 4 for the aerosol generator 3, a liquid supplier 5 and aconnector 6.

[0059] Liquid medication placed within the medication cup 2 is deliveredup through the liquid supplier 5 by capillary action. An oscillatorymotion of the liquid supplier 5 may also assist in pumping the liquidmedication upwards. An aerosol of the medication is generated by theaerosol generator 3, the aerosol then passes through the aerosolgenerator housing 4 and into the connector 6. A gas, such as air oroxygen, enters the connector 6 through a gas inlet 61 of the connector 6entraining the generated aerosol therein, and the air with entrainedaerosol medication is delivered through an outlet 62.

[0060] A controller 50, which may be connected to the apparatus 1 bymeans of a control lead 52, controls the generation of the aerosol andthe associated oscillation of the liquid supplier 5 (FIG. 2). Thecontroller 50 has a power supply socket 53 and provides power to drivethe generation of the aerosol as will be described in more detail below.In some embodiment, controller 50 may also be coupled to a ventilator.

[0061] Referring now to FIG. 3, the connector 6 has an aerosol inlet 60for aerosol from the generator 3, a gas inlet 61 and an outlet 62 foraerosol and gas. The connector 6 is of a general T-shape, thelongitudinal axis of the gas inlet 61 subtending an acute angle of 75°with the longitudinal axis of the aerosol inlet 60, as illustrated. Thelongitudinal axis of the gas inlet 61 is co-axial with the longitudinalaxis of the outlet 62, and the connector 6 slightly tapers outwardlybetween the gas inlet 61 and the outlet 62.

[0062] The connector 6 is configured to entrain the aerosol generated bythe aerosol generator 3, which passes from the aerosol generator housing4 into the aerosol inlet 60, with a gas, such as air, which passes inthrough the gas inlet 61. The entrained medication aerosol/gas mixturepasses out of the connector through the outlet 62.

[0063] The configuration of the connector 6 ensures the entrainedaerosol/gas mixture passes out of the connector 6 through the outlet 62regardless of the orientation of the connector 6, as illustrated inFIGS. 4(a) to 4(d). This is highly advantageous as it enables the userto operate the apparatus 1 in a wide variety of orientations, even withthe longitudinal axis of the outlet 62 vertical, while being assuredthat the aerosol/gas mixture is always delivered through the outlet 62.

[0064] It will be appreciated that the angle between the longitudinalaxis of the gas inlet 61 and the longitudinal axis of the aerosol inlet60 may be any angle in the range of from 60° to 90°, but preferably lessthan 90°, and most preferably from 60° to 80°.

[0065] The gas inlet 61 may be connected to a ventilator 70 which pumpsa gas, such as air into the connector 6. Alternatively, the apparatus 1may be employed during manual breathing with the gas inlet 61 being opento atmosphere.

[0066] The medication cup 2, as illustrated in FIGS. 5 to 8, comprises adelivery tube 10 centrally located within the cup 2, and an annularreservoir 11 which surrounds the tube 10. Four inlet slots 13 areprovided circumferentially spaced-apart around the wall of the tube 10and a base 12 of the reservoir 11 slopes downwardly and inwardly todirect liquid medication to flow through the inlet slots 13 in the wallof the delivery tube 10 and into the tube 10. The delivery tube 10extends below the level of the base 12 to form a central well 17. Byspacing the inlet slots 13 around the circumference of the tube 10, thisensures that the liquid medicament will flow into the well 17 in a widevariety of orientations of the cup 2.

[0067] In this case, the tube 10 is integral with the cup 2. However, itwill be appreciated that the tube 10 may alternatively be releasablyattached to the cup 2.

[0068] A plurality of protuberances 14 are formed on the inner wall ofthe medication cup 2 to indicate the maximum volume of liquid medicationto be inserted into the cup 2. In this case the maximum volume is about10 ml, although other volumes may be used.

[0069] The medication cup 2 has an annular skirt 15, as illustrated inFIG. 6, formed on the base of the cup 2 to enable the cup 2 to besupported in an upright orientation. This allows a user to, for example,stand the cup 2 safely on a table before pouring liquid medication intothe cup 2.

[0070] A screw thread 16 projects outwardly from the upright sides 18 ofthe cup 2 to enable releasable mounting of the medication cup 2 with theaerosol generator housing 4. The upright sides 18 have a chamfered edge99 at the mouth of the cup 2.

[0071] The medication cup 2 may be provided with a sealing sheet 19 tomaintain the liquid medication in the cup 2 (FIGS. 7 and 8). The sheet19 is releasably attached to the cup 2 and may be peeled off prior touse using a tab 19 a. In this way medication may be preloaded into thecup 2 and stored in this way in a condition which is ready for use whenrequired. It will be appreciated that the sealing sheet 19 may also beperforated by the downwardly protruding liquid supplier 5 during matingof the cup 2 with the housing 4 on assembly.

[0072] Information regarding, for example, the type of medicationcontained within the medication cup 2 or suitable dosages, or periods inwhich to use the medication may be provided on the sealing sheet 19. Theinformation may be, for example, printed onto the sheet 19, or affixedwith a label. The information may be, for example, in bar code format.

[0073] Referring now to FIGS. 9 to 12, the aerosol generator housing 4comprises an iso-conical neck 30 extending from a shoulder part 31. Theshoulder part 31 has four downwardly projecting and circumferentiallyspaced apart fingers 32, each finger 32 having a projection 33 on thelower end of the finger 32. In the assembled apparatus 1 the liquidsupplier 5 is releasably held within the housing 4 by means of asnap-fit engagement between the projections 33 and the liquid supplier 5(FIG. 9).

[0074] An annular sealing skirt 34 is formed on the shoulder part 31extending downwardly. The skirt 34 is angled to sealingly engage thechamfered edge 99 of the mouth of the medication cup 2 in a wedge-sealarrangement, when the apparatus 1 is assembled (FIG. 12).

[0075] A screw thread 35 is formed on the inner sides of the shoulderpart 31 to enable releasable mounting of the medication cup 2 to theaerosol generator housing 4. The neck 30 has an annular inwardprojection 36 formed above the shoulder part 31. The projection 36defines a space 37 within the hollow neck 30, in which the aerosolgenerator 3 may be received.

[0076] The housing 4 also includes a connector port 38 rigidly attachedto the upper surface of the shoulder part 31. Port 38 is configured toreceive a docking member 51 of the control lead 52. A control signalfrom the controller circuit 50 is passed through the control lead 52into the housing 4 via the port 38 to control the operation of theaerosol generator 3 and thus the generation of aerosol of medication.

[0077] The liquid supplier 5 comprises a head 20 and a stub 21 separatedby an annular protruding flange 26. A coiled spring 22 is coaxiallymounted around the stub 21. The outer diameter of the stub 21 is lessthan the inside diameter of the delivery tube 10, so that there is aclearance between the stub 21 and the tube 10 when the stub 21 isinserted into the tube 10 in the assembled apparatus 1(FIG. 12). Thecoiled spring 22 is at least partially compressed against the upper endof the delivery tube 10, and base 25 of the stub 21 extends below theslots 13 in the wall of the tube 10 and into the well 17 when assembled(FIG. 12).

[0078] The liquid supplier 5 includes two capillaries 23 which extendfrom the base 25 upwardly through the liquid supplier 5 to crown 24 ofthe head 20. The capillaries are open at the base 25 and at the crown 24(FIG. 9). The capillaries 23 provide the flow path for the liquidmedicament through the liquid supplier 5.

[0079] Illustrated in FIG. 12(a), the liquid supplier comprises aninsert piece 500 which may be slidably received in a slot 501 in thehead 20. Two elongate recesses in the insert piece 500 define thecapillaries 23. In use each capillary 23 operates in a manner similar toa point of a fountain pen.

[0080] The aerosol generator 3 comprises a non-planar member 40, whichmay be dome shaped in geometry, with a plurality of tapered aperturesextending between a front surface and a rear surface thereof, asdescribed in U.S. Pat. No. 5,164,740 (Ivri), U.S. Pat. No. 5,586,550(Ivri et al), U.S. Pat. No. 5,758,637 (Ivri et al), and U.S. Pat. No.6,085,740 (Ivri et al), the entire contents of which are incorporatedherein by reference. The aerosol generator 3 further comprises apiezoelectric element 42 having a central opening and a housing 44 (FIG.11). In the assembled apparatus 1, the non-planar member 40 and thepiezoelectric element 42 are enclosed within the housing 44 in the neckspace 37, and a shield 41 is fixedly attached to the shoulder part 31 bymeans of bonding a rim 43 to the housing 4 (FIGS. 11 and 12). The shield41 has a central aperture for receiving the crown 27 of head 20, whenassembled (FIG. 11).

[0081] The non-planar member 40 has a plurality of small holes throughwhich small particles of medication pass and are ejected to form theaerosol of medication. An anti-bacterial coating may be applied to themember 40 to ensure a sterile aerosol flow of particles into neck 30.

[0082] The connector 6 may be releasably mounted to the housing 4 bymeans of a push-fit engagement between the aerosol inlet 60 and the neck30 (FIG. 12).

[0083] To assemble the apparatus 1, the aerosol generator 3 is assembledand is inserted into the neck space 37 within a sleeve 45 between anO-ring seal 46 and the shield 41, which is bonded to the housing 4. Theaerosol generator 3 has freedom to move between the O-ring 46 and theshield 41. The liquid supplier 5 is engaged with the housing 4 by meansof the snap-fit of the projections 33 with the flange 26. Liquidmedication is then poured into the reservoir 11 and the housing 4 ismated with the medication cup 2, the stub 21 being inserted into thedelivery tube 10. The housing 4 and the cup 2 are rotated relative toone another to inter-engage the screw threads 35, 16 and thereby sealthe housing 4 to the medication cup 2. Finally, the aerosol inlet 60 ispushed over the neck 30 to mount the connector 6 in a push-fitarrangement.

[0084] As illustrated in FIG. 12, the aerosol generator 3 is displacedfrom the liquid medicament in the medication cup 2. The liquid supplier5 through capillary action and optionally in combination with anoscillatory pumping action delivers the liquid medicament to the aerosolgenerator 3.

[0085] In the assembled apparatus of FIG. 12, the crown 24 of the head20 extends through the aligned apertures in the shield 41. Piezoelectricelement 42 is connected to housing 44 to which the non-planar member 40is coupled. In this case, the crown 24 extends through the apertures andcontacts the non-planar member 40. In another embodiment of theinvention, the crown 24 extends through the apertures towards thenon-planar member 40 but terminates adjacent to the member 40 withoutcontacting member 40.

[0086] In use and referring particularly to FIG. 12, the control lead 52provides a power and a control signal to the piezoelectric element 42 tocause activation of the piezoelectric element 42, which in turn causesvibration of the non-planar member 40. In some embodiments, thisvibration may act against the force of the coiled spring 22 to cause anoscillatory plunging motion of the liquid supplier 5. Liquid medicationis thus delivered up through the capillaries 23 of the liquid supplier5. Alternatively, the liquid medication may be drawn up through thecapillaries 23 solely due to capillary action such that vibration ofnon-planar member 40 does not come into contact with head 20. Such aliquid delivery system may operate in a manner similar to that describedin U.S. Pat. No. 5,938,117 and copending U.S. patent application Ser.No. 09/678,410, filed Oct. 2, 2000, the complete disclosures of whichare herein incorporated by reference. The clearance between the deliverytube 10 and the stub 21 enables medication to flow from the reservoir 11into the well 17 (flow A). During the motion of the liquid supplier 5,base 25 of the stub 21 always remains below the level of the slots 13 toensure the liquid pressure in the capillaries 23 is not lost.

[0087] The droplets of liquid emerge from the capillaries 23 at thecrown 24 where they contact the non-planar member 40, the vibration ofwhich causes the liquid to pass through the holes in the member 40 andgenerates an aerosol of medication. The aerosol passes through the neck30 (flow B) into the aerosol inlet 60 until it meets the flow of gasfrom the gas inlet 61. The aerosol is entrained with the gas (flow C)and passes out of the connector 6 through the outlet 62 (flow D).

[0088] As illustrated in FIGS. 13 and 14, the outlet 62 of the connector6 may be connected in communication with a face mask 100 to assistbreathing of a patient. The connector 6 tapers outwardly in a step-wisemanner to define a female connection recess 110 at the outlet 62 (FIG.12). In this case, the face mask 100 is releasably mounted to theconnector 6 by means of an interference fit between an inlet arm 101 tothe face mask 100 and the recess 110.

[0089] The configuration of the T-shaped connector 6 means that anentrained mixture of aerosol medicament and gas is delivered from theconnector outlet 62 through the inlet arm 101 to the face mask 100 andon to the respiratory system of the patient, in a wide variety oforientations of the apparatus 1, as illustrated in FIGS. 14(a) and14(b). The apparatus 1 provides flexibility with regard to its possibleuses, and is thus suitable for use with, for example, a reclining orsleeping patient.

[0090] The apparatus 1 is lightweight. By mounting the apparatus 1 to aface mask 100 which may be worn by a patient, the apparatus 1 may beused during movement of the patient. During such movement the apparatus1 is supported by the face mask 100 due to the interference fit betweenthe inlet arm 101 and the female connection recess 110, and the facemask 100 is in turn held in place on the patient by means of straps 102.

[0091] A breathing mouthpiece 120 may be used as an alternative to theface mask 100, as illustrated in FIGS. 15 and 16. The mouthpiece 120 isreleasably mounted to the connector 6 by means of an interference fitbetween an inlet arm 121 to the mouthpiece 120 and the female connectionrecess 110 at the outlet 62.

[0092] As a further alternative, a tracheal tube 130 may be used toassist breathing of a patient (FIG. 17(a)). The tracheal tube 130 isreleasably mounted to the connector 6 by means of an interference fitbetween an inlet arm 131 to the tracheal tube 130 and the femaleconnection recess 110 at the outlet 62.

[0093] The apparatus 1 delivers an entrained aerosol medicament and gasmixture out through the outlet 62 regardless of the orientation of theapparatus 1. As illustrated in FIG. 17(b), the apparatus 1 may be usedin a configuration in which the medication cup 2 and the aerosolgenerator housing 4 are positioned above the connector 6. In this case,the liquid medicament is delivered through the liquid supplier 5 bygravitational action in addition to capillary action, and ins some casespumping action also.

[0094] An insert aperture 400 may be provided in the base 12 of themedication cup 2, as illustrated in FIG. 17(c). The aperture 400facilitates mating of an insert with the medication cup 2 incommunication with the reservoir 11. The insert may contain a volume ofliquid medicament and by mating the insert with the cup 2 via theaperture 400, the medicament can be delivered from the insert 400directly to the reservoir 11 of the medication cup 2. This arrangementhas the advantage that it is not necessary to disassemble the medicationcup 2 from the aerosol generator housing 4 to refill the cup 2 after allof the medication has been delivered in an aerosol form to therespiratory system of the patient.

[0095] After delivery of medicament from the insert to the reservoir 11,the insert is normally removed and a plug is inserted into the aperture400 to seal the reservoir 11.

[0096] A ventilator 200 may be connected to the gas inlet 61 of theconnector 6 by means of an interference fit between a ventilator tubeand the gas inlet 61. The connector 6 tapers outwardly near the gasinlet 61 to define a male connection protrusion 300 (FIG. 12) for asecure connection of the ventilator tube to the connector 6. Theventilator 200 may be used to pump air, or oxygen, or any other desiredgas mixture into the connector 6 through the gas inlet 61 where it isentrained with aerosol medicament.

[0097] A Y-shaped connector piece may be provided in the ventilatortubing circuitry to provide one flow path for inhalation and analternative flow path for exhalation. The Y-piece may be connected tothe tubing circuitry either side of the apparatus 1.

[0098] Alternatively, the gas inlet 61 may be left open to atmosphere,in which case the patient breathes in through the connector 6 in thenormal manner. In each case, the generated aerosol medicament isentrained with a gas, and the entrained mixture passes into therespiratory system of the patient through outlet 62.

[0099] The controller circuit 50 may be powered by an on-board powersource, such as a rechargeable battery 201. Alternatively the controllercircuit 50 may be connected to a remote power source by means of a powerconnection lead connected to the controller circuit 50 at power supplysocket 53 (FIG. 2). The lead may be for connection to a mains powersource 202, or alternatively to the ventilator 200 which provides thepower for the controller circuit 50.

[0100] The controller circuit 50 preferably includes an on/off switch 54to selectively control the operation of the aerosol generator 3, and twolight emitting diodes (LED's) 55, 56. One LED 55 indicates the aerosolgenerator 3 is in an active state generating aerosol of medicament, andthe other LED 56 indicates that the aerosol generator 3 is in a reststate. The switch 54 may alternatively be a reset switch.

[0101] Timing circuitry may further be provided as part of thecontroller circuit 50 to automatically switch between the active stateof operation of the aerosol generator 3 and the rest state. The timingsequence may be programmable to activate generation of the aerosol ashort period after commencement of an inhalation cycle, and to ceasegeneration of the aerosol a short period after commencement of anexhalation cycle. In this way, phasic delivery may be precisely timedwith aerosol generation.

[0102] Referring now to FIGS. 18 to 20, there are illustrated somepossible arrangements for using the apparatus 1, according to theinvention, for delivering medicament to a respiratory system 203 of apatient.

[0103] In the arrangement of FIG. 18, gas is pumped from the ventilator200 into the gas inlet 61 of the connector 6 (line G). The power sourcefor the controller circuit 50 which controls operation of the apparatus1 is provided by the ventilator 200 (line P).

[0104] In the arrangement of FIG. 19, gas is pumped from the ventilator200 into the gas inlet 61 of the connector 6 (line G). The power sourcefor the controller circuit 50 is provided by the battery 201 and/or themains power source 202 (lines P).

[0105] In the arrangement of FIG. 20, gas is drawn into the connector 6through the gas inlet 61 directly from the atmosphere 204 (line G). Thepower source for the controller circuit 50 is provided by the battery201 and/or the mains power source 202 and/or the ventilator 200 (linesP).

[0106] In the case where the power source is provided by the battery201, and the gas inlet 61 is open to the atmosphere 204, the apparatus 1is highly mobile. In particular, the apparatus 1 may be worn or held bythe patient as the patient takes exercise.

[0107]FIG. 21(a) illustrates a rear side of the controller circuit 50.The controller circuit 50 defines a recess 260 in the rear side of thecontroller circuit 50. The housing of the controller circuit 50 defiestwo ledges 261, 262 which overhang partially over recess 260, asillustrated most clearly in FIG. 21(b).

[0108] Referring now to FIG. 21(c), there is illustrated a mountingdevice 250. The mounting device 250 comprises means for attaching thedevice 250 to a support, such as an intravenous (IV) pole or amedi-rail, and hook means for supporting another medical device, in thiscase the controller circuit 50. The attachment means is provided, inthis case, by a releasable clamp 251. The attachment means mayalternatively be provided by a clip, such as a belt-clip.

[0109] The hook means is configured to define a plurality of, in thiscase four, support surfaces 252 for supporting the medical device in anupright configuration. The support surfaces 252 are provided by a lip253 protruding from a main body 254 of the mounting device 250. The lip253 is spaced from the main body 254 by two legs 255 (FIG. 21(c)).

[0110] In this case, the mounting device 250 is used to support thecontroller circuit 50, as illustrated in FIGS. 22 and 23. The lip 253 ofthe mounting device 250 may be inserted into the wider end of the recess260 in the rear side of the controller circuit 50 and then slid alongthe recess 260 until the lip 253 is partially enclosed behind the ledges261, 262. In this configuration, the controller circuit 50 is releasablysupported by the mounting device 250 (FIGS. 22 and 23).

[0111] The lip 253 comprises a plurality of support surfaces 252. Thisis advantageous, as it enables the controller circuit 50, or any othersuitable medical device, to be supported in an upright orientation whenthe mounting device 250 is clamped to a horizontal support, such as amedi-rail (FIG. 22), or when the mounting device 250 is clamped to avertical support, such as an IV pole (FIG. 23). It will be appreciatedthat the support surfaces 252 may be arranged at angles other than 90°relative to one another.

[0112] Referring now to FIGS. 24 and 25 there is illustrated anothermounting device which is similar to the mounting device 250 of FIGS. 21to 23, and similar elements are assigned the same reference numerals inFIGS. 24 and 25.

[0113] In this case, the hook means may be moved relative to theattachment means to selectively disassociate the hook means from theattachment means, which is provided in this case by a sleeve 270. Thesleeve 270 defines a groove 271 in which the main body 254 of themounting device may be slidably received (FIG. 24).

[0114] The sleeve 270 may be permanently or temporarily attached to asupport, such as a medi-rail, or an IV pole, or a ventilator 200, asillustrated in FIG. 25, by means of fixing pins inserted throughapertures 272 in sleeve 270.

[0115] In one embodiment, the apparatus is provided as part of aventilator circuit. In this case the ventilator circuit comprises anebulizing element, a fluid source coupled to the nebulizing element fordelivering fluid to the nebulizing element, and a ventilator whichdelivers and withdraws air from a patient. A control system is operablycoupled to the nebulizing element and the ventilator. The control systemactivates the nebulizing element shortly before initiation of aninhalation cycle, for example within a time period such as 20milliseconds and deactivates the nebulizing element shortly aftertermination of the inhalation cycle, for example within a time periodsuch as 20 milliseconds. In this way, the aerosol is generatedessentially only when the ventilator delivers a gas to the patient,thereby precisely controlling phasic delivery of a medication.

[0116] The apparatus will deliver medication in aerosol form to apatient in a wide variety of orientations of the apparatus. This ishighly desirable as the apparatus may be directly attached to a patientbreathing circuit and so reduce the length of tubing from the nebulizerto the mouth of the patient to less than 500 mm, usually less than 300mm.

[0117] The apparatus provides a medication cup which is releasable fromthe aerosol generator housing. This is a highly efficient arrangement.When the liquid medicament has all been delivered to a patientrespiratory system, the empty medication cup can be refilled withmedicament, or can be replaced with a new cap full of medication in aquick and simple step. In this manner the apparatus may be reused manytimes.

[0118] The power usage of the apparatus is relatively low, in this caseapproximately 1.5W, thus the associated heat generated during use isnegligible. The apparatus may be placed as close to the patient asdesired, even touching the patient for long periods of use withoutcausing discomfort to the patient, or without burning the patient.

[0119] The coiled spring is mounted to the liquid supplier, themedication cup is therefore free of all moving parts. The medication cupmay simply be replaced as a refill container when the liquid medicationhas been used.

[0120] The liquid supplier, is held within the aerosol generatorhousing. Therefore, there are no loose parts which could becontaminated, broken or lost during refill of the medication cup, orreplacement of the medication cup.

[0121] The aerosol generator produces an aerosol of medication within acontrolled range of aerosol particle sizes. No degradation of themedication occurs as a result of the aerosol generation process.

[0122] The invention is not limited to the embodiments hereinbeforedescribed which may be varied in construction and detail.

What is claimed is:
 1. An apparatus for delivery of a medicament to therespiratory system, the apparatus comprising: a reservoir adapted tohold a liquid medicament that is to be delivered to a respiratorysystem; an aerosol generator that is adapted to aerosolize the liquidmedicament; a liquid supplier adapted to deliver the liquid medicamentfrom the reservoir to the aerosol generator; and a connector to whichthe aerosol generator is operably connected, wherein the connectorcomprises a gas conduit having an inlet, and an outlet, and an aerosolsupply conduit, wherein the aerosol generator is configured to providethe aerosolized liquid medicament into the gas conduit through theaerosol supply conduit, and wherein the gas conduit is adapted to passgases to entrain the aerosolized liquid medicament.
 2. Apparatus asclaimed in claim 1, wherein the aerosol supply conduit subtends an angleless than 90° with the inlet side of the gas conduit.
 3. Apparatus asclaimed in claim 2, wherein the aerosol supply conduit subtends an angleof less than 80° with the inlet side of the gas conduit.
 4. Apparatus asclaimed in claim 3, wherein the aerosol supply conduit subtends an angleof about 75° with the inlet side of the gas conduit.
 5. Apparatus asclaimed in claim 1, further comprising an aerosol generator housing inwhich the aerosol generator is held, and wherein the connector ismounted to the aerosol generator housing at the aerosol supply conduit.6. Apparatus as claimed in claim 5, wherein the connector is releasablymounted to the aerosol generator housing at the aerosol supply conduit.7. Apparatus as claimed in claim 5, wherein the connector is mounted tothe aerosol generator housing by an interference fit between the aerosolgenerator housing and the aerosol supply conduit.
 8. Apparatus asclaimed in claim 1, wherein the outlet of the gas conduit at leastpartially tapers outwardly.
 9. Apparatus as claimed in claim 1, whereinthe gas conduit comprises an outlet connector that is adapted to connectthe gas conduit to a respiratory system.
 10. Apparatus as claimed inclaim 9, wherein the outlet of the gas conduit tapers outwardly in astep-wise manner to define a female connection recess at the outlet. 11.Apparatus as claimed in claim 9, further comprising a respiratoryconduit that is adapted to connect the outlet of the gas conduit to arespiratory system.
 12. Apparatus as claimed in claim 11, wherein therespiratory conduit is mounted to the connector at the outlet of the gasconduit.
 13. Apparatus as claimed in claim 12, wherein the respiratoryconduit is releasably mounted to the connector at the outlet of the gasconduit.
 14. Apparatus as claimed in claim 12, wherein the respiratoryconduit is mounted to the connector by an interference fit between therespiratory conduit and the outlet of the gas conduit.
 15. Apparatus asclaimed in claim 11, wherein the respiratory conduit is selected from agroup consisting of a mouthpiece, a face mask, and an intertrachealtube.
 16. Apparatus as claimed in claim 1, wherein the gas conduitcomprises an inlet connector that is adapted to connect the connector toa ventilator.
 17. Apparatus as claimed in claim 16, wherein the gasconduit comprises a male protrusion, and the inlet connector is at leastpartially provided by the protrusion.
 18. Apparatus as claimed in claim16, wherein further comprising a ventilator conduit to connect the gasconduit to a ventilator.
 19. Apparatus as claimed in claim 18, whereinthe ventilator conduit is mounted to the inlet connector of the gasconduit.
 20. Apparatus as claimed in claim 19, wherein the ventilatorconduit is releasably mounted to the inlet connector of the gas conduit.21. Apparatus as claimed in claim 19, wherein the ventilator conduit ismounted to the inlet connector by an interference fit between theventilator conduit and the gas conduit.
 22. Apparatus as claimed inclaim 1, wherein the aerosol generator comprises a vibratable memberhaving a plurality of apertures extending between a first surface and asecond surface thereof.
 23. Apparatus as claimed in claim 22, firstsurface is adapted to receive the liquid medicament from the liquidsupplier.
 24. Apparatus as claimed in claim 22, wherein the aerosolgenerator is configured to generator the aerosol at the second surfaceof the vibratable member.
 25. Apparatus as claimed in claim 22, whereinthe vibratable member is dome shaped in geometry.
 26. Apparatus asclaimed in claim 22, wherein the vibratable member comprises apiezoelectric element.
 27. Apparatus for delivery of medicament to arespiratory system comprising: a medication cup that is adapted toreceive a liquid medicament to be delivered to a respiratory system; anaerosol generator; a housing in which the aerosol generator is disposed,wherein the housing is releasably coupled to the medication cup; aliquid supplier that is adapted to deliver the liquid medicament fromthe cup to the aerosol generator; and a connector that is adapted toreceive aerosol generated by the aerosol generator is delivered. 28.Apparatus as claimed in claim 27, wherein the aerosol generator isdisplaced from the medication cup, and wherein the liquid supplier isadapted to deliver the liquid medicament between the cup and the aerosolgenerator.
 29. Apparatus as claimed in claim 27, wherein the liquidsupplier is releasably mounted to the aerosol generator housing. 30.Apparatus as claimed in claim 29, wherein the liquid supplier isreleasably mounted to the aerosol generator housing by a snap-fitengagement.
 31. Apparatus as claimed in claim 30, wherein the aerosolgenerator housing comprises at least one finger for snap-fit engagementwith a neck of the liquid supplier.
 32. Apparatus as claimed in claim31, wherein the aerosol generator housing comprises a plurality offingers which are circumferentially spaced apart.
 33. Apparatus asclaimed in claim 31, wherein the aerosol generator housing comprisesfour fingers.
 34. Apparatus as claimed in claim 31, wherein the liquidsupplier defines an annular protruding neck.
 35. Apparatus as claimed inclaim 27, wherein the medication cup is sealingly mounted to the aerosolgenerator housing.
 36. Apparatus as claimed in claim 35, wherein theaerosol generator housing comprises a skirt extending to sealinglyengage the medication cup.
 37. Apparatus as claimed in claim 36, whereinthe skirt has an angled surface to sealingly engage a chamfered mouth ofthe medication cup.
 38. Apparatus as claimed in claim 27, wherein themedication cup is releasably mounted to the aerosol generator housing bya screw-thread engagement.
 39. Apparatus as claimed in claim 27, whereinthe medication cup defines a reservoir for the liquid medicament, andfurther comprising a medication delivery tube extending from thereservoir, the liquid supplier being at least partially received withinthe delivery tube for delivery of the liquid medicament to the aerosolgenerator.
 40. Apparatus as claimed in claim 39, wherein the deliverytube is provided by the medication cup.
 41. Apparatus as claimed inclaim 40, wherein the delivery tube is integral with the medication cup.42. Apparatus as claimed in claim 40, wherein the delivery tube isattached to the medication cup.
 43. Apparatus as claimed in claim 39,wherein the delivery tube has an inlet that is adapted to receive theliquid medicament from the reservoir.
 44. Apparatus as claimed in claim43, wherein the inlet includes a number of inlet slots which arecircumferentially spaced-apart around the delivery tube.
 45. Apparatusas claimed in claim 43, wherein a base of the reservoir at leastpartially slopes downwards towards the delivery tube.
 46. Apparatus asclaimed in claim 43, wherein at least part of the liquid supplierextends below the inlet.
 47. Apparatus as claimed in claims 39, whereinthe reservoir includes a refill port.
 48. Apparatus as claimed in claim47, wherein the refill port is provided in a base of the reservoir. 49.Apparatus as claimed in claim 48, further comprising a plug toselectively seal the refill port.
 50. Apparatus as claimed in claim 39,wherein the reservoir comprises a central well from which the deliverytube extends.
 51. Apparatus as claimed in claim 39, wherein the liquidsupplier comprises a resilient member to reciprocate the liquid supplierin the delivery tube.
 52. Apparatus as claimed in claim 51, wherein theresilient member is engagable with a free end of the delivery tube. 53.Apparatus as claimed in claim 51, wherein the resilient member comprisesa spring.
 54. Apparatus as claimed in claim 39, wherein the medicationcup comprises at least one depth indicator to indicate the volume ofliquid medicament in the reservoir.
 55. Apparatus as claimed in claim54, wherein the depth indicator comprises an internal marking on a wallof the medication cup.
 56. Apparatus as claimed in claim 27, wherein themedication cup has a base that is adapted to hold the cup in an uprightorientation when receiving the liquid medicament.
 57. Apparatus asclaimed in claim 56, wherein the base includes a support skirt extendingfrom the base of the medication cup.
 58. Apparatus for delivery ofmedicament to a respiratory system comprising: a reservoir that isadapted to hold a liquid medicament to be delivered to a respiratorysystem; an aerosol generator; a housing for the aerosol generator; aliquid supplier that is adapted to deliver the liquid medicament fromthe reservoir to the aerosol generator; and a connector through whichaerosol generated by the aerosol generator is delivered; wherein theaerosol generator housing includes a signal interface that is configuredto receive control signals to control the operation of the aerosolgenerator.
 59. Apparatus as claimed in claim 58, further comprising acontroller to control the operation of the aerosol generator, thecontroller being connectable to the signal interface.
 60. Apparatus asclaimed in claim 59, wherein the controller comprises control meanshaving an on-board power source.
 61. Apparatus as claimed in claim 60,wherein the power source is a battery.
 62. Apparatus as claimed in claim61, wherein the battery is rechargeable.
 63. Apparatus as claimed inclaim 59, wherein the controller includes a power connector, the powerconnector being connectable to a remote power source.
 64. Apparatus asclaimed in claim 63, wherein the power connector comprises a ventilatorpower connection lead for connection to a ventilator power source. 65.Apparatus as claimed in claim 63, wherein the power connector comprisesa mains power connection lead for connection to a main power source. 66.Apparatus as claimed in claim 64, wherein the power connection lead isdetachable from a socket in the control means
 67. Apparatus as claimedin any 59, wherein the controller comprises a timer to automaticallyswitch the aerosol generator between an active state and a rest state.68. Apparatus as claimed in claim 67, wherein the timer is selectivelyprogrammable.
 69. Apparatus as claimed in claim 59, wherein thecontroller comprises user interface to selectively control the operationof the aerosol generator.
 70. Apparatus as claimed in claim 69, whereinthe user interface is remote from the aerosol generator housing. 71.Apparatus as claimed in claim 69, wherein the user interface comprisesan on/off switch.
 72. Apparatus as claimed in claim 70, wherein the userinterface means comprises a reset switch.
 73. Apparatus as claimed inclaims 59, wherein the controller comprises status indication means toindicate the operational state of the aerosol generator.
 74. Apparatusas claimed in claim 73, wherein the status indication means comprises atleast one visual indicator.
 75. Apparatus as claimed in claim 74,wherein the status indication means comprises two light emitting diodes,one to indicate an active state of operation of the aerosol generator,and the other to indicate a rest state of the aerosol generator. 76.Apparatus as claimed in claim 59, wherein the controller comprises ahousing having a support to receive a mounting device.
 77. Apparatus asclaimed in claim 76, wherein the support comprises a recess in thehousing for receiving a mounting device.
 78. Apparatus as claimed inclaim 77, wherein the support comprises at least one ledge overhangingthe recess for engagement of a mounting device in the recess. 79.Apparatus as claimed in claim 78, wherein the support comprises twoledges on opposite sides of the recess.
 80. Apparatus as claimed inclaims 76, further comprising a mounting device to support thecontroller.
 81. Apparatus as claimed in claim 80, wherein the mountingdevice comprises means for attaching the mounting device to a support;and hook means for supporting the control housing, the hook means beingconfigured to define a plurality of support surfaces for supporting thecontrol housing in an upright configuration.
 82. Apparatus as claimed inclaim 81, wherein the support surfaces each comprise a lip protrudingfrom a main body of the mounting device.
 83. Apparatus as claimed inclaim 82, wherein the lip is engagable in the recess in the housing tosupport the control means.
 84. Apparatus as claimed in claim 81, whereinthe hook means defines four support surfaces.
 85. Apparatus as claimedin claim 84, wherein each support surface is substantially perpendicularto an adjacent support surface.
 86. Apparatus as claimed in claim 81,wherein the attachment means is releasable.
 87. Apparatus as claimed inclaim 81, wherein the attachment means comprises a clamp.
 88. Apparatusas claimed in any of claim 81, wherein the attachment means comprises aclip.
 89. Apparatus as claimed in claim 81, wherein the hook means ismovable relative to the attachment means to selectively disassociate thehook means from the attachment means.
 90. A device as claimed in claim89, wherein the attachment means defines a groove in which the hookmeans is slidable to selectively disassociate the hook means from theattachment means.
 91. A connector to facilitate the delivery of amedicament to a respiratory system, the connector comprising: aconnector body having a gas conduit having an inlet and an outlet, anaerosol supply conduit coupled to the gas conduit between the inlet andthe outlet, wherein the connector has a generally T-shape, and whereinthe aerosol supply conduit subtends an angle of less than 90° with theinlet of the gas conduit.
 92. A connector as claimed in claim 91,wherein the aerosol supply conduit subtends an angle of less than 80°with the gas conduit.
 93. A connector as claimed in claim 92, whereinthe aerosol supply 2 conduit subtends an angle of about 75° with the gasconduit.
 94. A medication cup for holding a liquid medicament fordelivery to an aerosol generator, the medication cup comprising: areservoir containing a liquid; a connector operably coupled to thereservoir, wherein the connector is adapted to be connected to anaerosol generator; and a releasable seal to maintain the medicament inthe cup.
 95. A medication cup as claimed in claim 94, wherein thereleasable seal comprises a sealing sheet releasably attached to thecup.
 96. A medication cup as claimed in claim 95, wherein the sealingsheeting includes a peel tab.
 97. A medication cup as claimed in claim94, wherein the releasable seal includes a code.
 98. Apparatus fordelivery of medicament to the respiratory system comprising: amedication cup that is adapted to hold a liquid medication to bedelivered to a respiratory system; an aerosol generator; a housing forthe aerosol generator; a liquid supplier that is adapted to deliver theliquid medicament from the cup to the aerosol generator; and a connectorthrough which aerosol generated by the aerosol generator is delivered,wherein the liquid supplier is mounted to the generator housing. 99.Apparatus for delivery of medicament to the respiratory systemcomprising: a medication cup that is adapted to hold a liquid medicationto be delivered to a respiratory system; an aerosol generator; a housingfor the aerosol generator; a liquid supplier that is adapted to deliverthe liquid medicament from the cup to the aerosol generator; and aconnector through which aerosol generated by the aerosol generator isdelivered; wherein the aerosol generator housing has signal connectionmeans for connection to a control means to control the operation of theaerosol generator.
 100. Apparatus for delivery of medicament to therespiratory system comprising: a medication cup that is adapted to holda liquid medication to be delivered to a respiratory system; an aerosolgenerator; a housing for the aerosol generator; a liquid supplier thatis adapted to deliver the liquid medicament from the cup to the aerosolgenerator; and a connector through which aerosol generated by theaerosol generator is delivered, wherein the medication cup is releasablymounted to the aerosol generator housing.
 101. A nebulizer systemcomprising: at least one tubing section having an inlet and an outletfor delivering air to a patient from a ventilator; a nebulizer which isadapted to deliver a nebulized fluid to the tubing section forinhalation by a patient on a ventilator, the nebulizer having avibrating element having a plurality of openings therein, the vibratingelement having a front side and a back side; and wherein vibration ofthe vibrating element is adapted to move fluid from the back side of thevibrating element through the plurality of openings to produce thenebulized fluid which enters the tubing section for delivery to thepatient.
 102. A nebulizer as claimed in claim 101, wherein the at leastone tubing section forms an air path; and further comprising a source offluid that is separated from the air path by the vibrating element. 103.A nebulizer as claimed in claim 101, wherein the at least one tubingsection includes a T-shaped section.
 104. A nebulizer as claimed inclaim 101, further comprising a capillary feed system that is adapted toprovide fluid to the back side of the vibrating element.
 105. Anebulizer as claimed in claim 101, further comprising a ring-shapedpiezoelectric element to vibrate the vibratable element.
 106. Anebulizer as claimed in claim 101, wherein the openings in the vibratingelement are sized to eject liquid droplets such that about 70% or moreof the droplets by weight have a size in the range from about 1 to about5 micrometers.
 107. A nebulizing device for a ventilator, comprising: anebulizing element; a fluid delivery system that is adapted to supplyfluid to the nebulizing element; and at least one tube section whichdefines a delivery path to the patient, the delivery path being definedby a distance between the nebulizing element and the patient, thedelivery path having a length of less than about 500 mm.
 108. Anebulizing device for a ventilator as claimed in claim 107, wherein theat least one tube section has a delivery path of less than about 300 mm.109. A nebulizing device for a ventilator as claimed in claim 107,wherein the nebulizing element comprises a vibrating element withopenings therein, wherein the vibrating element has a front side and aback side, wherein the delivery path is defined at one end by the frontside of the vibrating element, and wherein the fluid is deliveredthrough the openings in the vibrating element upon vibration of thevibrating element; and wherein the fluid delivery system is adapted todeliver fluid to the back side of the vibrating element.
 110. Anebulizing device for a ventilator as claimed in claims 107, wherein theat least one tube section includes a T-shaped section having a topsection and a central section, the nebulizing element being positionedat a bottom of the central section.
 111. A nebulizing device for aventilator as claimed in claim 110, wherein the central section forms anangle of from 60° to 80° with the top section.
 112. A nebulizing devicefor a ventilator as claimed in claim 107, wherein the at least one tubesection includes a Y-shaped section which separates into a first arm forinhalation and a second arm for exhalation, the nebulizing element beingcoupled to a second tube section which is connected to the Y-section.113. A nebulizing device for a ventilator as claimed in claim 112,wherein the second tube section is a T-shaped section which is attachedto the Y-section.
 114. A nebulizing device for a ventilator as claimedin claim 107, wherein the delivery path through the at least one tubesection is substantially free of baffles and flow disrupters.
 115. Amethod of providing a nebulized fluid to a patient, comprising the stepsof: providing a nebulizing element and a source of fluid coupled to thenebulizing element, the nebulizing element delivering nebulized fluidinto at least one tube section; coupling the tube section to a patient'sairway, with the tube section defining a delivery path to the patient,the delivery path being defined by a distance between the nebulizingelement and the patient, the delivery path having a length of less than500 mm.
 116. A method for providing a nebulized fluid to a patient, themethod comprising: vibrating a vibratable member having a plurality ofapertures that is in contact with a fluid to produce a nebulized fluid;permitting the nebulized fluid to eject into a conduit that is coupledto a ventilator; and supplying a gas from the ventilator to supply theaerosolized fluid to the patient's airway.
 117. A ventilator circuitcomprising: a nebulizing element; a fluid delivery system that isadapted to supply a fluid to the nebulizing element; a ventilator thatis adapted to deliver and withdraw gases from a patient; and a controlsystem operably coupled to the nebulizing element for controlling thenebulizing element and the ventilator.
 118. A ventilator circuit as inclaim 117, wherein the control system is configured to activate thenebulizing element within 20 milliseconds of initiation of an inhalationcycle and to deactivate the nebulizing element within 20 milliseconds oftermination of the inhalation cycle.
 119. A ventilator circuit as inclaim 117, further comprising a source of fluid.
 120. A ventilatorcircuit as claimed in claim 119, wherein the nebulizing elementcomprises a vibrating element with openings therein, the vibratingelement having a front side and a back side, the fluid being deliveredthrough the openings in the vibrating element upon vibration of thevibrating element, and the source of fluid providing fluid to the backside of the vibrating element.
 121. A method for providing a nebulizedfluid to a patient, the method comprising: vibrating a vibratable memberhaving a plurality of apertures that is in contact with a fluid toproduce a nebulized fluid; permitting the nebulized fluid to eject intoa conduit that is coupled to a ventilator; and supplying a gas from theventilator to supply the aerosolized fluid to the patient's airway; andcontrolling vibration of the vibratable member and the gas supply fromthe ventilator such that the nebulized fluid is produced immediatelybefore the supply of gas from the ventilator and stops immediately afterstopping the supply of gas from the ventilator.